Heel Pain
No-Incision Treatment for Heel Pain
We are pleased to introduce extracorporeal shock wave therapy for chronic
heel pain. Similar to lithotripsy for treatment of kidney stones, this
treatment utilizes high-energy shock waves that penetrate tissue in the
heel to help relieve pain and improve function by stimulating or triggering
you body's own repair mechanisms. This is a no-incision treatment
that can be done in our office, with no hospitalization required.
Heel Pain Has Many Causes
In our pursuit of healthy bodies, pain can be an enemy. In some instances,
however, it is of biological benefit. Pain that occurs right after an
injury or early in an illness may play a protective role, often warning
us about the damage we've suffered.
When we sprain an ankle, for example, the pain warns us that the ligament
and soft tissues may be frayed and bruised, and that further activity
may cause additional injury.
Pain, such as may occur in our heels, also alerts us to seek medical attention.
This alert is of utmost importance because of the many afflictions that
contribute to heel pain.
Heel Pain
In our pursuit of healthy bodies, pain can be an enemy. In some instances,
however, it is of biological benefit. Pain that occurs right after an
injury or early in an illness may play a protective role, often warning
us about the damage we've suffered.
When we sprain an ankle, for example, the pain warns us that the ligament
and soft tissues may be frayed and bruised, and that further activity
may cause additional injury.
Pain, such as may occur in our heels, also alerts us to seek medical attention.
This alert is of utmost importance because of the many afflictions that
contribute to heel pain
Heel Spurs
A common cause of heel pain is the heel spur, a bony growth on the underside
of the heel bone. The spur, visible by X-ray, appears as a protrusion
that can extend forward as much as half an inch. When there is no indication
of bone enlargement, the condition is sometimes referred to as "heel
spur syndrome."
Heel spurs result from strain on the muscles and ligaments of the foot,
by stretching of the long band of tissue that connects the heel and the
ball of the foot, and by repeated tearing away of the lining or membrane
that covers the heel bone. These conditions may result from biomechanical
imbalance, running or jogging, improperly fitted or excessively worn shoes,
or obesity.
Plantar Facilitis
Both heel pain and heel spurs are frequently associated with an inflammation
of the band of fibrous connective tissue (fascia) running along the bottom
(plantar surface) of the foot, from the heel to the ball of the foot.
The inflammation is called plantar fasciitis. It is common among athletes
who run and jump a lot, and it can be quite painful.
The condition occurs when the plantar fascia is strained over time beyond
its normal extension, causing the soft tissue fibers of the fascia to
tear or stretch at points along its length; this leads to inflammation,
pain, and possibly the growth of a bone spur where it attaches to the
heel bone.
The inflammation may be aggravated by shoes that lack appropriate support,
especially in the arch area, and by the chronic irritation that sometimes
accompanies an athletic lifestyle.
Resting provides only temporary relief. When you resume walking, particularly
after a night's sleep, you may experience a sudden elongation of the
fascia band, which stretches and pulls on the heel. As you walk, the heel
pain may lessen or even disappear, but that may be just a false sense
of relief. The pain often returns after prolonged rest or extensive walking.
Excessive Pronation
Heel pain sometimes results from excessive pronation. Pronation is the
normal flexible motion and flattening of the arch of the foot that allows
it to adapt to ground surfaces and absorb shock in the normal walking pattern.
As you walk, the heel contacts the ground first; the weight shifts first
to the outside of the foot, then moves toward the big toe. The arch rises,
the foot generally rolls upward and outward, becoming rigid and stable
in order to lift the body and move it forward. Excessive pronation—excessive
inward motion—can create an abnormal amount of stretching and pulling
on the ligaments and tendons attaching to the bottom back of the heel
bone. Excessive pronation may also contribute to injury to the hip, knee,
and lower back.
Disease and Heel Pain
Some general health conditions can also bring about heel pain.
- Rheumatoid arthritis and other forms of arthritis, including gout, which
usually manifests itself in the big toe joint, can cause heel discomfort
in some cases.
- Heel pain may also be the result of an inflamed bursa (bursitis), a small,
irritated sack of fluid; a neuroma (a nerve growth); or other soft-tissue
growth. Such heel pain may be associated with a heel spur or may mimic
the pain of a heel spur.
- Haglund's deformity ("pump bump") is a bone enlargement at
the back of the heel bone, in the area where the achilles tendon attaches
to the bone. This sometimes painful deformity generally is the result
of bursitis caused by pressure against the shoe and can be aggravated
by the height or stitching of a heel counter of a particular shoe.
- Pain at the back of the heel is associated with inflammation of the achilles
tendon as it runs behind the ankle and inserts on the back surface of
the heel bone. The inflammation is called achilles tendinitis. It is common
among people who run and walk a lot and have tight tendons. The condition
occurs when the tendon is strained over time, causing the fibers to tear
or stretch along its length, or at its insertion on to the heel bone.
This leads to inflammation, pain, and the possible growth of a bone spur
on the back of the heel bone. The inflammation is aggravated by the chronic
irritation that sometimes accompanies an active lifestyle and certain
activities that strain an already tight tendon.
- Bone bruises are common heel injuries. A bone bruise or contusion is an
inflammation of the tissues that cover the heel bone. A bone bruise is
a sharply painful injury caused by the direct impact of a hard object
or surface on the foot.
- Stress fractures of the heel bone also can occur, although infrequently.
Heel Pain Tips
- If you have experienced painful heels try wearing your shoes around your
house in the evening. Don't wear slippers or socks or go barefoot.
You may also try gentle calf stretches for 20 to 30 seconds on each leg.
This is best done barefoot, leaning forward towards a wall with one foot
forward and one foot back.
- If the pain persists longer than one month, you should visit a podiatrist
for evaluation and treatment. Your feet should not hurt, and professional
podiatric care may be required to help relieve your discomfort.
- If you have not exercised in a long time, consult your podiatric physician
before starting a new exercise program.
- Begin an exercise program slowly. Don't go too far or too fast.
- Purchase and maintain good shoes and replace them regularly.
- Stretch each foot and achilles tendon before and after exercise.
- Avoid uneven walking surfaces or stepping on rocks as much as possible.
- Avoid going barefoot on hard surfaces.
- Vary the incline on a treadmill during exercise. Nobody walks uphill all the time.
- If it hurts, stop. Don't try to "work through the pain."